The No Surprises Act was enacted in 2020 as part of a comprehensive year-end package of spending and COVID-19 legislation. In December of 2021, the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) issued interim final rules (IFRs) detailing new obligations of providers to provide good faith estimates (GFEs) of expected costs to patients who are uninsured or not using their insurance to pay for services. However, the administration chose to delay rules detailing how GFEs must be provided to patients who intend to use their insurance. 

On September 16, 2022, HHS, the Departments of Labor and Treasury jointly issued a request for information (RFI) seeking proposals on the mechanism and standards under which GFEs must be sent to insurance plans, which insurers must then apply to the terms of the patient’s plan and create an advance explanation of benefits for the patient. 

On November 15, 2022, APA Services submitted a response to this RFI, which highlights the steep administrative burdens providers must face, the unnecessary burdens imposed by the earlier No Surprises Act IFRs, and the lack of support for behavioral health clinicians to adopt interoperable electronic health record systems. The response proposes an exemption for behavioral health clinicians to GFE standards proposal concerning the No Surprises Act, a prohibition on insurers using GFEs as a means to limit patient care, and a single easy-to-use portal through which GFEs can be submitted.

APA Services expects that the administration will follow through on its commitment to issue proposed rules for public comment, rather than another round of IFRs. The association will continue to monitor further rulemaking under the No Surprises Act as it continues to unfold.